Question
If we perform only ipsilateral acoustic reflex test rather than ipsilateral and contralateral, how is our billing code modified?
Answer
That would a -52 for abbreviated procedure. The 92568, the code for acoustic reflex is valued on the basis of ipsilateral or contralateral for both ears. If you do only ipsilateral for each ear, basically you did half of the total procedure, you did not modify the protocol but you just didn't do everything and so a -52 modifier would be appropriate there to say: "We didn't do all that we typically do but we did enough that we have some clinical conclusions to make about status of the reflexes outcome."
I work in ENT and still have one doctor who really likes reflex decay. When I'm marking the charges, do I mark tymps, reflexes, and decay, or does decay assume the others?"
All of the codes, all the procedures, are stand-alone, with one exception, and that is defined in the book. So if you do decay, you've got to mark tymps and reflexes and decay individually on the encounter form for all the elements that you did. Decay does not subsume the rest.
We have one code in our family of codes whereby, by definition, it does subsume other procedure codes;that is 99527. In the CPT manual, it does state, in parentheses, "includes 92553 and 92556." So 57 subsumes 53 and 56. But that's the only one that does. Everything else is very much a standalone code, and you'll mark it based upon what you do.
Robert Fifer, Ph.D., is the Director of Audiology and Speech-Language Pathology for the Mailman Center for Child Development at the University of Miami School of Medicine. He is also an Audiology Online Contributing Editor in the area of Coding and Billing. He is the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee.
Editor's Note - The above is a partial transcript from the Coding and Billing QNA Live e-Seminar that was conducted on Audiology Online on June 27, 2007. (The recorded version is available here - Also the complete edited transcript is available here. The format of the session was different from most traditional presentations as we solicited questions ahead of time and also solicited questions during the event and had Dr. Fifer focus on answering those questions during the live session. We have published the transcript from the seminar in a semi-rough format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers. Submitted questions are bolded, followed by Dr. Fifer's response. Dr. Fifer is a frequent Contributing Editor for Audiology Online in this area, look for additional Coding and Billing QNA sessions on our home page in the near future. - Paul Dybala, Ph.D. - Editor
